Life's Simple 7 and Nonalcoholic Fatty Liver Disease: The Multiethnic Study of Atherosclerosis

BackgroundThe American Heart Association (AHA) has defined Life's Simple 7 (LS7) as a measure of overall cardiovascular health . Nonalcoholic fatty liver disease (NAFLD) has been involved as a risk factor for cardiovascular disease. We evaluated the association between LS7 and NAFLD.MethodsWe evaluated participants form the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cardiovascular health score was calculated from the Life's Simple 7 metrics. A score of 0-8 was considered inadequate, 9-10 average, and 11-14 optimal. NAFLD was defined using noncontrast cardiac computed tomography (CT) and a liver/spleen attenuation ratio (L/S) < 1. Multivariable regression were performed to evaluate the association.ResultsOur cross-sectional analysis of 3901 participants showed 19% (n = 747) had optimal cardiovascular health, 33% (n = 1270) had average, and 48% (n = 1884) had inadequate. White participants were most likely to have an optimal score (51%, n = 378), whereas African American participants had the lowest proportion with optimal scores (16%, n = 120; P < 0.001). The overall prevalence of NAFLD was 18% with a distribution of 7%, 14%, and 25% in the optimal, average, and inadequate score categories, respectively (P < 0.001). Adjusted for risk factors, average and optimal health categories had lower odds of NAFLD compared to those with inadequate scores: odds ratio for average, 0.44 (95% confidence interval 0.36-0.54); optimal, odds ratio 0.19 (95% confidence interval 0.14-0.26). This association was similar across gender, race and age groups.ConclusionA more favorable cardiovascular health score was associated with a lower prevalence of NAFLD. This study may suggest a potential of Life's Simple 7 in the prevention of liver disease.     

Luteal phase transvaginal scan examinations have better diagnostic potential for showing focal subendometrial adenomyosis

The objective of this preliminary observational study was to monitor changes in focal cystic and non-cystic subendometrial lesions reminiscent of adenomyosis seen during the luteal phase of the cycle by repeating transvaginal ultrasound scan examinations during the follicular phase. Five patients who presented with abnormal uterine bleeding with or without dysmenorrhoea showed such lesions, following luteal phase transvaginal scanning. All lesions became smaller and less conspicuous, or an indiscriminate endometrial/myometrial interface was seen in the suspected areas during the follicular phase. Midcycle scanning of one patient showed enhancement of the irregular subendometrial area, but still without reaching the same size, or attaining an echogenic pattern as seen during the initial luteal phase examination. We hypothesise that luteal phase transvaginal scan examinations of the uterus may have better potential for diagnosing focal subendometrial adenomyosis than follicular phase scanning. This is because of the echogenic characteristics of a secretory endometrium relative to the neighbouring inner myometrium. More work is needed to verify these findings and to test our hypothesis.     

Novel linear diamine disubstituted polycyclic 'cage' derivatives as potential antimycobacterial candidates

As a part of an ongoing project to develop highly potent antituberculosis therapeutics, a series novel polycyclic ‘cage’ tetra‐amines were synthesized and screened for in‐vitro antituberculosis activities against the H₃₇Rv strain of tuberculosis. Three disubstituted polycyclic moieties, namely pentacyclodecane, pentacycloundecane, and tricyclodecane, were used in this study. Compounds 5 and 7 showed similar activity to SQ109 at a MIC of 1 μm while compounds 4 , 6 and 8 displayed MIC activity at 1 < MIC<10 μm against H₃₇Rv strain of tuberculosis. Compounds 5 , 7 and SQ109 were selected for further screening against, multi‐drug resistant, (R1097) and extensively drug resistant, (X149) strains of tuberculosis. Compound 5 showed anti‐TB activity of a MIC = 1 μm against multi‐drug resistant strain (R1097) and <1 μM against extensively drug resistant strain (X149) while compound 7 and SQ109 showed excellent anti‐TB activity against both drug‐resistant strains at a MIC <1 μm . This study demonstrates the first reported analysis of pentacyclo[5.3.0.0^2,5.0^3,9.0^4,8]decane as a potential therapeutic agent.     

Physician cardiovascular disease risk factor management: practices in France vs the United States

Cardiovascular risk factor management by French vs US primary care physicians was studied. A survey was conducted that found that French physicians spend >20 minutes while US physicians spend five to 10 minutes (P<.001) addressing cardiovascular risk with patients. Fifty-three percent of French (vs 33% of US) physicians focus more on lifestyle modification and less on medication management (P<.0001). Sixty-nine percent of French physicians spend 0% to 20% of their time on administration while 65% of US physicians spend 10% to 30% (P=.0028). Fifty-one percent of French physicians see patients in one to three months for follow-up, while 51% of US physicians see patients in three to six months (P<.0001). Eighty-seven percent of French (vs 39% of US) physicians have guidelines available in the examination room either frequently or very frequently. US physicians report disparities in care more frequently than do French physicians (P<.0001). Forty-nine percent of French (vs 10% of US) physicians believe that they have relative freedom to practice medicine (P<.001). US physicians report greater administrative efforts, frustration, and disparities in their practice. French physicians focus more of their efforts on lifestyle management and see their patients more frequently and for a longer visit time.     

Drain after elective laparoscopic cholecystectomy. A randomized multicentre controlled trial

Background

Routine drainage after laparoscopic cholecystectomy is still debatable. The present study was designed to assess the role of drains in laparoscopic cholecystectomy performed for nonacutely inflamed gallbladder.

Methods

After laparoscopic gallbladder removal, 53 patients were randomized to have a suction drain positioned in the subhepatic space and 53 patients to have a sham drain. The primary outcome measure was the presence of subhepatic fluid collection at abdominal ultrasonography, performed 24?h after surgery. Secondary outcome measures were postoperative abdominal and shoulder tip pain, use of analgesics, nausea, vomiting, and morbidity.

Results

Subhepatic fluid collection was not found in 45 patients (84.9?%) in group A and in 46 patients (86.8?%) in group B (difference 1.9 (95?% confidence interval ?11.37 to 15.17; P?=?0.998). No significant difference in visual analogue scale scores with respect to abdominal and shoulder pain, use of parenteral ketorolac, nausea, and vomiting were found in either group. Two (1.9?%) significant hemorrhagic events occurred postoperatively. Wound infection was observed in three patients (5.7?%) in group A and two patients (3.8?%) in group B (difference 1.9 (95?% CI ?6.19 to 9.99; P?=?0.997).

Conclusions

The present study was unable to prove that the drain was useful in elective, uncomplicated LC.     

Pentacyclo-undecane derived cyclic tetra-amines: Synthesis and evaluation as potent anti-tuberculosis agents

As part of an ongoing effort to develop highly potent anti-tuberculosis agents, fourteen pentacyclo-undecane (PCU) tetra-amine compounds were synthesized and screened for their in vitro anti-mycobacterial activity against two TB strains, H37Rv and XDR 194 [an extensively drug-resistant strain of tuberculosis]. Using the broth macrodilution method, nitrofuranylamide based compounds (6a and 6b) showed almost similar activities against the H37Rv strain of Mycobacterium tuberculosis when compared with the control drug, ethambutol. N-Geranyl piperazine PCU (8a) and trans–trans farnesyl piperazine PCU (8b) were 3.2 and 3.7 times more potent than commercially available ethambutol. Both isoprenyl PCU tetra-amine derivatives and N-decyl piperazine PCU (9a) were highly active against the XDR 194 strain of tuberculosis with MICs in the range of 0.63–3.02 μM. Cytotoxicities (IC₅₀) of isoprenyl based compounds (8a, 8b) and compound 9a were tested on a mammalian cell line [MDBK (Madin Darby bovine kidney epithelium)] with values of 30, 24 and 25 μM respectively.     

Is self‐rated health associated with ideal cardiovascular health? The Multi‐Ethnic Study of Atherosclerosis

Background

Self‐rated health (SRH) is an indicator of health status—a determinant of health‐promoting behaviors and a predictor of morbidity/mortality. Little is known about the association between SRH and ideal cardiovascular health (CVH), as measured by the AHA Life's Simple 7 (LS7) metrics, or whether the relationship between SRH and CVH differs by race/ethnicity.

Hypothesis

Favorable SRH is associated with better CVH.

Methods

We conducted a cross‐sectional analysis of 6457 men and women (4 race/ethnicities) who participated in the Multi‐Ethnic Study of Atherosclerosis. SRH was measured on a 5‐point Likert scale (excellent, very good, good, fair, and poor). CVH was assessed using the LS7 metrics, each scored from 0 to 2, with a total score of 0 to 14. Scores of 0 to 8 indicate inadequate, 9 to 10, average, and 11 to 14, optimal CVH. ORs and 95% CIs were calculated for associations between SRH and CVH scores using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance, and chronic diseases.

Results

Mean age of participants was 62 ± 10 years; 53% were female. Odds of ideal CVH increased as SRH improved. Compared with poor–fair SRH, adjusted ORs and 95% CIs for optimal CVH by SRH status were excellent, 4.9 (3.4–7.0); very good, 2.2 (1.6–3.1); and good, 1.5 (1.1–2.1). Results were similar by race/ethnicity, sex, and age groups.

Conclusions

More favorable SRH was associated with better CVH, irrespective of sex, race/ethnicity, or age. Further research could explore whether optimization of SRH predicts CVH.     

SQ109 analogues as potential antimicrobial candidates

The antimicrobial activity of five novel SQ109 derivatives including SQ109 against bacteria, yeast and filamentous fungi is reported herein. Using broth microdilution techniques, compounds 2 and 3 were found to be active against most tested fungi and bacteria, with minimum inhibitory concentrations (MICs) ranging from 0.98 to 31 μg ml⁻¹, except for Klebsiella pneumonia where the MIC was 250 μg ml⁻¹. SQ109 and derivative 4 did not show any significant activity against most of the organisms used. However, their reduced derivatives 1 and 5 showed promising activity with MICs between 0.49 and 62.5 μg ml⁻¹ against most of the microorganisms used.